Severe left atrium calcification (heart within a heart)

Abstract

A 55-year-old man with a history of childhood rheumatic fever and subsequent rheumatic mitral stenosis after aortic and mitral valve replacement presented with abdominal pain and early satiety. On examination, his abdomen was tender to palpation, and he had lower extremity edema. Posteroanterior and lateral chest radiographs showed right pleural effusion, global cardiomegaly, and severe mural calcification of the left atrium (Figures 1-3). Right heart catheterization demonstrated a low cardiac index, moderately to markedly elevated pulmonary capillary wedge pressures, and severe pulmonary hypertension. His severe right heart failure was likely secondary to pulmonary hypertension, which had developed in the setting of longstanding rheumatic mitral valve disease.Severe calcification of the left atrium has been most commonly associated with rheumatic heart disease. 1,2